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t� a iiiiiiiiii� �i � � iftillllllillli tllllllllllllll � i� � � � � � � � <br /> j Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnyironmental, Inc. z g-e A03� Date ul Page Z <br /> 4045 North Wilson Way-Stockton,California-95205-(249)467-100$-Fax(209)467-1118 <br /> Client Project Manager <br /> 4E GzS/ Tests Required <br /> ZV&AAJ A1661441,1 <br /> Phone Number <br /> 2�9 G 7 i�Ca <br /> Samplers (Signature) / Invoice <br /> Protect Name l? f�AJ�4C �i t�` AG EJR <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Comp <br /> Number Description Grab Air Corns <br /> t 66187 <br /> w A d ai �13s" J(gI G 1 Ix X I i t <br /> "w_t 66188 <br /> I <br /> a y 2S-0 <br /> MWZA a i 6619 L- <br /> M Z.s-4 1 /a, "y L <br /> M"J z A 1Z,'A % I' 66190 <br /> o�zs-ai <br /> I� <br /> 66191 F <br /> z � <br /> !Z5d} 66192 , <br /> In feral loco _x 66193 <br /> ayZsal <br /> Ratin y { gnature ecetve y (Signature) t <br />� _a},etelTime <br /> RelirFqtrished b Si ne e ' <br /> Y ( 8 Received by (Signature} � � f3ateJTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Y Date/Time <br /> Dispatched by (Signature) DatetTime I Received for Laboratory by raj/ D e(Time <br /> GY � <br /> Method of Shtpm ora ar me <br /> Special Instruc tons I hereby authorize the performance of the above indicated work <br />